NR 546 Final Exam V2 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Final
Exam) | Chamberlain University
1. A patient taking Clozapine for treatment-resistant schizophrenia reports a sore throat and
a temperature of 101.5°F. What is the most critical next step for the PMHNP?
A. Prescribe a broad-spectrum antibiotic.
B. Order an immediate Absolute Neutrophil Count (ANC).
C. Advise the patient to take acetaminophen and monitor symptoms.
D. Discontinue Clozapine and switch to Olanzapine.
Correct Answer: B
Explanation: Clozapine carries a black box warning for agranulocytosis, a potentially fatal
drop in white blood cell count. Fever and sore throat are clinical indicators of possible
infection resulting from low neutrophil levels. An immediate ANC is required to determine
if the medication must be permanently discontinued per REMS guidelines.
2. Which of the following medications is most likely to cause significant weight gain and
metabolic syndrome in a patient with bipolar disorder?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
,D. Olanzapine
Correct Answer: D
Explanation: Olanzapine is known for having a very high risk of metabolic side effects,
including significant weight gain and dyslipidemia. PMHNPs must monitor waist
circumference, fasting glucose, and lipid profiles regularly for patients on this medication.
Comparing options, Ziprasidone and Aripiprazole are generally considered more weight-
neutral.
3. A patient starting Lithium therapy for Bipolar I Disorder needs education on maintaining
consistent levels. Which of the following should the patient be told to avoid?
A. Consistent salt intake
B. Drinking 2 liters of water daily
C. Moderate exercise
D. NSAIDs such as Ibuprofen
Correct Answer: D
Explanation: NSAIDs can reduce renal clearance of Lithium, leading to toxic accumulations
of the drug. Patients should be educated to use acetaminophen for pain instead of
ibuprofen or naproxen. Maintaining a stable intake of sodium and water is also essential to
prevent fluctuations in serum lithium levels.
, 4. A 24-year-old female patient is being treated with Valproate for mood stabilization. What
is a primary concern for the PMHNP regarding this specific patient population?
A. Potential for sudden weight loss and anorexia.
B. Risk of polycystic ovary syndrome (PCOS) and teratogenicity.
C. Increased risk of hypertension.
D. Risk of developing Type 1 Diabetes.
Correct Answer: B
Explanation: Valproate is associated with a high risk of teratogenicity, specifically neural
tube defects, and should be avoided in women of childbearing age if possible. It is also
linked to the development of PCOS in younger women. Effective contraception and regular
monitoring of reproductive health are mandatory if this drug is prescribed.
5. Which antidepressant is preferred for a patient who is concerned about sexual dysfunction
and weight gain?
A. Paroxetine
B. Bupropion
C. Venlafaxine
D. Amitriptyline
Correct Answer: B
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Final
Exam) | Chamberlain University
1. A patient taking Clozapine for treatment-resistant schizophrenia reports a sore throat and
a temperature of 101.5°F. What is the most critical next step for the PMHNP?
A. Prescribe a broad-spectrum antibiotic.
B. Order an immediate Absolute Neutrophil Count (ANC).
C. Advise the patient to take acetaminophen and monitor symptoms.
D. Discontinue Clozapine and switch to Olanzapine.
Correct Answer: B
Explanation: Clozapine carries a black box warning for agranulocytosis, a potentially fatal
drop in white blood cell count. Fever and sore throat are clinical indicators of possible
infection resulting from low neutrophil levels. An immediate ANC is required to determine
if the medication must be permanently discontinued per REMS guidelines.
2. Which of the following medications is most likely to cause significant weight gain and
metabolic syndrome in a patient with bipolar disorder?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
,D. Olanzapine
Correct Answer: D
Explanation: Olanzapine is known for having a very high risk of metabolic side effects,
including significant weight gain and dyslipidemia. PMHNPs must monitor waist
circumference, fasting glucose, and lipid profiles regularly for patients on this medication.
Comparing options, Ziprasidone and Aripiprazole are generally considered more weight-
neutral.
3. A patient starting Lithium therapy for Bipolar I Disorder needs education on maintaining
consistent levels. Which of the following should the patient be told to avoid?
A. Consistent salt intake
B. Drinking 2 liters of water daily
C. Moderate exercise
D. NSAIDs such as Ibuprofen
Correct Answer: D
Explanation: NSAIDs can reduce renal clearance of Lithium, leading to toxic accumulations
of the drug. Patients should be educated to use acetaminophen for pain instead of
ibuprofen or naproxen. Maintaining a stable intake of sodium and water is also essential to
prevent fluctuations in serum lithium levels.
, 4. A 24-year-old female patient is being treated with Valproate for mood stabilization. What
is a primary concern for the PMHNP regarding this specific patient population?
A. Potential for sudden weight loss and anorexia.
B. Risk of polycystic ovary syndrome (PCOS) and teratogenicity.
C. Increased risk of hypertension.
D. Risk of developing Type 1 Diabetes.
Correct Answer: B
Explanation: Valproate is associated with a high risk of teratogenicity, specifically neural
tube defects, and should be avoided in women of childbearing age if possible. It is also
linked to the development of PCOS in younger women. Effective contraception and regular
monitoring of reproductive health are mandatory if this drug is prescribed.
5. Which antidepressant is preferred for a patient who is concerned about sexual dysfunction
and weight gain?
A. Paroxetine
B. Bupropion
C. Venlafaxine
D. Amitriptyline
Correct Answer: B
